Endovascular approaches to arteriovenous fistula.

AVFs differ in their characteristics, natural history, and response to interventions. These differences need to be considered when planning treatment. Endovascular treatments have emerged as a mainstay of treatment of all types of AVMs. They can be used as definitive therapy for acquired arteriovenous malformation, in remote or high-risk locations, and in elderly or otherwise debilitated patients. Endovascular control is often helpful in open repair of acquired AVF. Endovascular techniques are essential in the management of congenital AVF and are the first line of interventional therapy. In these cases, repeated interventions are the rule, and careful imaging and planning is the key to success.

120-day comparative analysis of adhesion grade and quantity, mesh contraction, and tissue response to a novel omega-3 fatty acid bioabsorbable barrier macroporous mesh after intraperitoneal placement.

PURPOSE: This study aimed to evaluate adhesion formation, mesh contraction, and tissue response to an omega-3 fatty acid barrier-coated lightweight polypropylene mesh (C-Qur) after intra-abdominal placement, and compare these properties to those of other commercially available meshes. MATERIALS AND METHODS: After randomization, 3 x 3 cm pieces of Atrium C-Qur, Mesh ProLite Ultra, Composix, Parietex, Proceed, Sepramesh, and DualMesh were sewn to the intact peritoneum on either side of a midline incision in 41 New Zealand white rabbits. Necropsy was performed at 120 days, and explants were evaluated for adhesion grade, adhesion amount, and mesh contraction. Histologic evaluation included extent of capsule formation, abdominal wall tissue ingrowth, degrees of inflammation and vascularization of the surrounding tissue, and the presence of mesothelialization. Results. There were no significant differences between the C-Qur mesh and the commercially available meshes tested with regard to adhesion grade or amount, although percentage adhesion coverage for the C-Qur mesh was much less than for Composix and Proceed. The C-Qur mesh contracted less than all meshes, significantly less (P < .05) than DualMesh or Proceed. DualMesh exhibited the greatest amount of capsule formation and inflammation on its parietal side as compared with the other meshes. CONCLUSIONS: Placing lightweight polypropylene mesh with an omega-3 fatty acid barrier coating intraperitoneally results in more favorable adhesion characteristics compared with Composix and Proceed meshes at 120-day explantation after intraperitoneal placement. The minimal amount of contraction and favorable tissue response in comparison to other commercially available meshes makes C-Qur mesh a practical alternative for laparoscopic and open ventral hernia repair.

Laparoscopic gastric resection for gastrointestinal stromal tumors.

BACKGROUND: This study aimed to review clinical outcomes for patients selected to undergo laparoscopic resection for gastrointestinal stromal tumor (GIST) of the stomach. METHODS: All 112 laparoscopic gastric resections performed from February 1995 to March 2007 were reviewed. Pre- and postoperative variables were analyzed, and data are given as mean +/- standard deviation. RESULTS: Laparoscopic gastric resection was attempted for 63 GIST in 61 patients (31 men and 30 women) with a mean age was 59.1 +/- 19 years. The tumors were located at the fundus (n = 19), antrum (n = 18), body (n = 17), gastroesophageal junction/cardia (n = 7), and pylorus (n = 2). Common presentations were upper gastrointestinal bleed (n = 29) and incidental finding on esophagogastroduodenoscopy (n = 17). The laparoscopic procedures performed were partial gastrectomy (n = 52), antrectomy (n = 4), esophagogastrectomy (n = 3), and endoscopically assisted and/or transgastric resection (n = 3). There was one conversion to open procedure for control of bleeding from the spleen. The mean tumor size was 3.8 +/- 1.8 cm. Negative surgical margins were achieved in all but one case. The mean operative time was 151.9 +/- 67.3 min, and the mean estimated blood loss was 97.4 +/- 200.7 ml. A regular diet was resumed at a mean of 2.9 +/- 1.6 days, and the mean length of hospital stay was 3.9 +/- 2.2 days. The perioperative complication rate was 16.4% including deep vein thrombosis postoperative bleed, anastomotic stricture, and incisional hernia. One mortality occurred, due to respiratory failure. The GISTs included 48 rated as low risk, six rated as intermediate risk, and nine rated as high malignant potential. At a mean follow-up period of 15 +/- 21.8 months (range, 0-103 months), three of nine patients with high malignant potential GIST experienced, respectively, metastatic disease to the liver, liver and lung, and peritoneum. At this writing, all the other patients are disease free. CONCLUSIONS: Laparoscopic gastric resection for GIST is a feasible option. Adequate oncologic resection was achieved with 98.4% of patients chosen for laparoscopic resection. Resection margin positivity and recurrence rates are low after laparoscopic approaches for appropriately selected patients with GIST, demonstrating favorable characteristics.